Medical advances help design targeted breast-cancer treatments

Treatment of breast cancers is moving away from a cookie-cutter approach as medical research continues to uncover new ways to fight the disease.

In Bexar County, about 1,000 newly diagnosed breast-cancer cases are recorded annually, coupled with 177 breast-cancer deaths, according to the Texas Department of State Health Services. The agency also forecasts 14,651 new breast-cancer cases and 2,767 deaths statewide this year.

“What’s happening is there’s been a move away from one size fits all. It used to be common to do surgery and chemotherapy on the majority of breast cancers, but that’s no longer true today,” Lang said. “We only use chemo if the cancer is very aggressive.”

Emerging technology is paving the way for these new treatments.

“We have a number of molecular profiling tests that have come out based on genetic screening done on nearly all of our patients.The results of those genetic profiles have allowed us to look well beyond what the pathologist can tell us about a given tumor.” — Dr. Amy Lang

Physicians have learned a number of things, she added.

“We find sometimes that large tumors aren’t necessarily more aggressive,” she said. “We’ve also learned that some cancer cells simply do not respond to chemotherapy because the genetics of the cell will not permit it to respond. As a result, we are treating a fraction of the number of women with chemo than we used to.”

She said, “In situ — noninvasive cancers — typically were treated with lumpectomy and radiation, plus some hormone treatment, but today, older women may need no treatment. Younger women, however, are not comfortable not getting treatment. As a result, for younger patients with in situ breast cancers, additional treatments are often prescribed.”

Advances in imagery are also helping, she added.

“New technology in mammograms — tomosynthesis 3-D mammography – is a major advancement in diagnosis of breast cancers,” the oncologist said. “The scan creates a three-dimensional image of breast tissue, which leads to even better identification of breast-cancer cells. There are also new drug therapies coming online that may prove very beneficial in treating breast cancer.”

Dr. Oscar Ochoa, a board-certified plastic and reconstructive surgeon, said the common belief that breast cancers run in families and thus greatly increases a woman’s risk of developing a cancer isn’t accurate.

“The majority – 80 percent of all breast cancers — are new breast cancers in a family,” he said. “Fifty percent of women (come in) with a noticeable change in the physical presentation of their breasts – nipple discharge, lumps or other changes that raise an alarm. The other half of breast cancers are caught on mammogram where the patient had no idea she had a problem.”

Echoing Lang’s observations, Ochoa said, “We’re finding out more and more about the genetics of breast cancer. As a result, we are getting closer and closer to designing drugs based on the genetic profile of the patient. That will mean less reliance on chemo and more reliance on targeted treatments tailored to an individual patient’s genetic makeup.”

Ochoa and his group, PRMA Plastic Surgery, 9635 Huebner Road, specialize in reconstructive work following a mastectomy or other procedures, which may change a breast’s appearance.

During the next decade, “one of the most exciting developments” will be tissue engineering using a 3-D bioprinter to construct the replacement tissue for a breast (or breasts) following a mastectomy, he said.

“Using 3-D imaging we will be able to make a perfect copy of the cavity left after the cancer is removed to enable us to print out the replacement tissue,” Ochoa added.

Women and men ideally will take steps to reduce their risk of breast and other cancers, the doctors said.

“We know there’s a link between alcohol and breast cancer,” Lang said. “Women who consume more than three drinks a week are at higher risk for developing breast cancer, and the more she drinks, the greater the risk. As the alcohol content goes up, the estrogen levels go up, too, and we know higher estrogen levels bring about breast cancer.”

Controlling your weight, exercise and a low-fat diet with plenty of vegetables lowers the risk of breast cancer, Lang said.

For more, visit the American Cancer Society at www.cancer.org and the Centers for Disease Control and Prevention at www.cdc.gov/cancer/breast.